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Mader R, Pappone N, Baraliakos X, Eshed I, Sarzi-Puttini P, Atzeni F, Bieber A, Novofastovski I, Kiefer D, Verlaan JJ, Ambrosino P, Buskila D, Armas JB, Khan MA. Diffuse Idiopathic Skeletal Hyperostosis (DISH) and a Possible Inflammatory Component. Curr Rheumatol Rep 2021; 23:6. [PMID: 33496875 DOI: 10.1007/s11926-020-00972-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Diffuse Idiopathic Skeletal Hyperostosis (DISH) is considered a metabolic condition, characterized by new bone formation affecting mainly at entheseal sites. Enthesitis and enthesopathies occur not only in the axial skeleton but also at some peripheral sites, and they resemble to some extent the enthesitis that is a cardinal feature in spondyloarthritis (SpA), which is an inflammatory disease. RECENT FINDINGS We review the possible non-metabolic mechanism such as inflammation that may also be involved at some stage and help promote new bone formation in DISH. We discuss supporting pathogenic mechanisms for a local inflammation at sites typically affected by this disease, and that is also supported by imaging studies that report some similarities between DISH and SpA. Local inflammation, either primary or secondary to metabolic derangements, may contribute to new bone formation in DISH. This new hypothesis is expected to stimulate further research in both the metabolic and inflammatory pathways in order to better understand the mechanisms that lead to new bone formation. This may lead to development of measures that will help in earlier detection and effective management before damage occurs.
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Affiliation(s)
- Reuven Mader
- Rheumatic Diseases Unit, Ha'Emek MC, Afula, Israel.
| | - Nicola Pappone
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Iris Eshed
- Department of Radiology, Musculoskeletal imaging Unit, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Fabiola Atzeni
- Rheumatology Unit, University of Messina, Messina, Italy
| | - Amir Bieber
- Rheumatic Diseases Unit, Ha'Emek MC, Afula, Israel
| | | | - David Kiefer
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Bochum, Germany
| | - Jorrit-Jan Verlaan
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Dan Buskila
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Jacome Bruges Armas
- Medicine, Rheumatology, SEEBMO, Hospital de Santo Espirito da ilha Terceira, Universidade do Porto, Angra do Heroismo, Portugal
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